What to worry about

People spend too much time worrying about minor health issues or looking for quick fixes and not enough thinking about things that are important to their health.

Royal Australian College of GPs WA chairman Tim Koh has detailed the five things your GP wishes you would worry more about and the five things that shouldn’t be of such concern.

He believes a good ongoing relationship with your GP helps in working out what is important and what is not for your own situation. For example, it’s hard to talk about weight loss with someone you are meeting for the first time.

“If you don’t have that trust and you don’t have that sense that this person is really interested in their long-term health, then it’s a lot harder to engage and buy into that idea,” Dr Koh says.

Patients who are able to refocus their attention on what matters when it comes to their health can reap rewards when it comes to quality of life and longevity.

WEIGHT

Nearly two-thirds of us are overweight or obese and yet weight is almost never on the agenda when we go to see our GP.

Despite its status as an important risk factor for many serious health conditions, including type 2 diabetes, cardiovascular disease and cancer, it is an often overlooked health priority.

Australians have been steadily piling on the kilos in recent decades with the proportion of adults overweight or obese growing from 56.3 per cent to 62.8 per cent between 1995 and 2011-12, according to Australian Bureau of Statistics figures.

The problem is worst in the 55-64 age group where obesity levels peak at 36.7 per cent of people registering a BMI of 30 or more.

Royal Australian College of GPs WA chairman Tim Koh said people gradually put on weight as they got older but frequently ignored it as a long-term cumulative factor influencing other areas of their health.

“When you consider the spectrum of what being overweight does to your health, it affects almost every system of your body but particularly (those involved with) the three biggest causes of death in Australia which are heart attack, stroke and cancer,” he said.

It could be a tricky subject which some people were uncomfortable discussing.

“People seldom come in and say I think I have a real problem with my weight,” Dr Koh said. “I try to get people on the scales as often as possible and measure their height as well and really show them where they sit.

“It is one of these problems that when you show them their BMI and what that constitutes in terms of being overweight and obese, people are often really shocked.”

Dr Koh said losing weight required long-term behavioural change which was impossible unless a patient bought into the idea that they wanted to change.

“That’s where general practice is really well placed because we are seeing people regularly, so even if someone doesn’t buy into it straight away, if they are getting constantly reminded they are more likely to slowly embrace that change,” he said.

Dr Koh said a GP’s main interest was in maintaining healthy weight loss.

“From our point of view, we are not really interested in what you weigh in a month’s time or three months’ time, we’re interested in what are you are going to weigh in a year’s time or three years’ time, that’s where you get the real benefits.”

MENTAL HEALTH

You might seek out your GP to discuss concerns about fatigue or sleeplessness but underlying the symptoms could be a much larger mental health problem. Dr Koh said it was common for people to overlook mental health as a cause of other symptoms.

“Insomnia is a really common one, (when you ask patients) why aren’t you sleeping, it’s because people are over-thinking and ruminating over things,” he said. “Often with worry, anxiety will manifest with quite strong bodily symptoms like chest pain or feeling like you can’t breathe properly. When you ask patients ‘How do you feel when you can’t breathe properly’, often they are having a panic attack.”

Dr Koh said significant inroads had been made to encourage people to seek help for mental health but stigma still remained.

“Although GPs are seeing a lot of patients and are carrying most of the burden for managing mental health in Australia, for every patient that comes in there are probably many more that don’t,” Dr Koh said. “There’s a perception that managing mental health means seeing a therapist or taking medication and there are reasons people don’t want to follow that path.

“But there are a lot of simple strategies that you can take on — exercising regularly, reducing your alcohol consumption and psychological techniques like meditation and mindfulness that are really helpful for people, particularly with mood-based problems.”

The latest Australian Health Survey revealed 13.6 per cent of Australians are affected by mental health and behavioural conditions, led largely by issues including depression which affects 9.7 per cent of the population and anxiety 3.8 per cent of the population.

SKIN CANCER

Not enough people attend their GP for regular skin checks and with nearly one third of all cancers diagnosed in Australia skin cancer, this is a dangerous oversight.

The perception that all skin cancers are dark and pigmented like melanomas fools people into a false sense of security when in fact basal cell carcinomas appear as small spots that are red, pale or pearly in colour and squamous cell carcinomas are scaly red areas that may bleed, ulcers or sores that won’t heal.

A melanoma, the rarest but the most dangerous form of skin cancer, can have a number of different colours through it and is characterised by asymmetry, a spreading or irregular border and rapid growth over a period of weeks or months.

Dr Koh said while skin cancer was more common in white European skin types they could happen to anyone and in any location on the body.

Yearly skin checks were recommended, however those people who had a lot of sun exposure or who had had a skin cancer removed in the past needed to go for more frequent skin checks possibly three to six monthly depending on their circumstances.

“We know once you’ve had one skin cancer you are highly likely to have more,” he said.

“Go and get your skin assessed by your GP and work out what is sensible.”

ALCOHOL

Patients often delude themselves when it comes to their alcohol consumption.

But the truth is in WA, at 25.4 per cent, we have the highest proportion of people exceeding the maximum two alcoholic drinks per day recommended by the National Health and Medical Research Council to reduce the lifetime risk of harm from alcohol-related disease or injury. This compares to the national average of 19.5 per cent.

Nearly half (44 per cent) of adults admit drinking beyond the four drinks recommended by the NHMRC for single-occasion drinking.

A big part of the problem lay in people overestimating what constitutes a standard drink, Dr Koh said.

“I find it is really a problem for alcoholic beverages that are poured in larger volumes, particularly wine and spirits, where it is hard to measure exactly how much you have consumed,” he said. “A lot of people pour a glass of wine and it is more than two standard drinks in the one glass.

“Most people underestimate how much they are drinking and they are often shocked when you work out in terms of alcoholic units how much they are consuming and how much they should be consuming.”

Dr Koh said the issue was clouded by a perception that a degree of drinking was healthy.

“There’s some data that alcohol consumption improves your cardiac health, which is still a debatable thing,” he said. “What we do know is that it increases the incidence of liver disease, which is really common in the community. Alcohol is also classified as a carcinogen, so it substantially increases your cancer risk.

“People don’t realise that alcohol makes their sleep patterns worse. A lot of people drink because it will put them to sleep but actually it substantially diminishes the quality of your sleep and you are more likely to wake up during the night if you consume alcohol. So it worsens sleep patterns and conditions such sleep apnoea, plus a lot of other health issues.”

It also had a negative effect on other health problems, including high blood pressure and mental health conditions.

CHEST PAIN

It is alarming how many people will ignore chest pain, even though it is an important warning sign of one of Australia’s biggest killers — heart attack.

“People seem to fairly happily sit on it and we know with heart attack that the earlier you intervene and get assessed, diagnosed and managed, the less likely you are to get more severe risks and damage,” Dr Koh said.

Often people mistakenly thought the pain must be severe but a heart attack can be heralded by even mild chest pain or discomfort - or no chest pain at all. Some come with pain, pressure or heaviness in the jaw, neck, shoulders, back or arms.

“Chest pain is really common and it often does represent something serious like heart attack but despite that, we often see people who have come in with a heart attack and say they have been having pain for the last few days or longer,” Dr Koh said.

“It is really common and often in people who have had a previous heart attack.”

Dr Koh said people should always seek medical advice when they had chest pain, particularly people who had been diagnosed with cardiovascular disease.

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